What is the effect of Amlodipine (Calcium Channel Blocker)?

From the Guidelines

Amlodipine should be used with caution in patients with heart failure, as it may not provide any functional or survival benefit, according to the 2013 ACCF/AHA guideline for the management of heart failure 1.

Key Points to Consider

• Amlodipine is a calcium channel blocker primarily used to treat high blood pressure (hypertension) and coronary artery disease.
• The typical starting dose is 5 mg once daily, which may be increased to a maximum of 10 mg daily if needed for blood pressure control.
• Amlodipine works by relaxing blood vessels, allowing blood to flow more easily and reducing the workload on the heart.
• This medication should be taken at the same time each day, with or without food, and patients should continue taking it even if feeling well, as hypertension often has no symptoms.
• Common side effects include ankle swelling, headache, flushing, and dizziness, which typically improve over time.
• Amlodipine has a long half-life, allowing for once-daily dosing, and it's generally well-tolerated in elderly patients and those with kidney problems.
• Unlike some other blood pressure medications, amlodipine doesn't require dosage adjustments for patients with renal impairment.
• It's essential to monitor blood pressure regularly while taking this medication and to inform healthcare providers about all other medications being taken to avoid potential interactions.
• The ALLHAT study found that amlodipine was as effective as chlorthalidone in most categories, except for heart failure, where it was significantly inferior 1.
• The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure suggests that calcium channel blockers, such as amlodipine, may be useful in diabetics, particularly as part of combination therapy to control blood pressure 1.

Important Considerations

• Amlodipine may not be the best choice for patients with heart failure, as it has failed to demonstrate any functional or survival benefit in patients with HF 1.
• However, amlodipine may be considered in the management of hypertension or ischemic heart disease in patients with HF because it is generally well-tolerated and had neutral effects on morbidity and mortality in large RCTs.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Amlodipine Overview

• Amlodipine is a dihydropyridine calcium channel blocker that has been widely used for over two decades 2.
• It has good efficacy and safety, as well as strong evidence from large randomized controlled trials for cardiovascular event reduction 2.

Amlodipine in Hypertension Treatment

• Amlodipine should be considered a first-line antihypertensive agent due to its beneficial effects on blood pressure and patient outcomes 2.
• The American Heart Association recommends a blood pressure goal of <140/90 mm Hg for most adults with hypertension, and <130/80 mm Hg for patients with diabetes mellitus, chronic kidney disease, or known coronary artery disease (CAD) 3.
• Amlodipine has been shown to have a positive impact on cardiovascular mortality and morbidity in hypertensive individuals when used in combination with other antihypertensive agents, such as angiotensin-converting enzyme (ACE) inhibitors 4, 5.

Amlodipine and ACE Inhibitors

• The combination of amlodipine and ACE inhibitors has been shown to result in a greater reduction of both systolic and diastolic blood pressure compared to amlodipine monotherapy 5.
• This combination therapy also offers superior blood pressure control, fewer adverse events, and better tolerability in hypertensive patients 5.
• ACE inhibitors have been proven to prevent progressive deterioration in left ventricular function and reduce mortality in patients with CAD and left ventricular dysfunction or congestive heart failure 6.

Clinical Evidence

• Clinical trials indicate that the combination of amlodipine and ACE inhibitors may have a positive impact on cardiovascular mortality and morbidity in hypertensive individuals 4, 5.
• Amlodipine has been shown to have good efficacy and safety in the treatment of hypertension, and should be considered a first-line antihypertensive agent 2.
• The American Heart Association recommends the use of ACE inhibitors, calcium channel blockers, and other antihypertensive agents in the treatment of hypertension and CAD 3.